Retrospective Study
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World J Gastroenterol. Oct 14, 2014; 20(38): 13950-13955
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13950
Enhanced recovery after surgery vs conventional care in emergency colorectal surgery
Varut Lohsiriwat
Varut Lohsiriwat, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Lohsiriwat V solely contributed to this paper.
Supported by Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Correspondence to: Varut Lohsiriwat, MD, PhD, Associate Professor of Surgery, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, No. 2 Wang Lang Road, Bangkok 10700, Thailand. bolloon@hotmail.com
Telephone: +662-419-8005 Fax: +662-412-1370
Received: April 17, 2014
Revised: June 8, 2014
Accepted: June 25, 2014
Published online: October 14, 2014
Processing time: 181 Days and 16.8 Hours
Abstract

AIM: To investigate the feasibility and beneficial effects of enhanced recovery after surgery (ERAS) programme in the setting of emergency colorectal surgery.

METHODS: Between January 2011 and October 2013, patients undergoing emergency resection for obstructing colorectal cancer at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand using ERAS programme were compared with those using conventional care (1:2 ratio). They were matched for their age, gender, ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score, and type of surgery. Primary outcomes were length of hospital stay and postoperative morbidity. Secondary outcomes included gastrointestinal recovery, 30-d readmission, and time interval from surgery to chemotherapy.

RESULTS: Twenty patients treated with ERAS programme were compared with 40 patients receiving conventional postoperative care. Median of hospital stay was shorter in the ERAS group: 5.5 d (range: 3-16) vs 7.5 d (range: 5-25), P = 0.009. The ERAS group had a non-significant reduction in the incidence of postoperative complication (25% vs 48%, P = 0.094). No 30-d mortality and readmission occurred. Patients with ERAS programme had a shorter time to first flatus (1.6 d vs 2.8 d, P < 0.001) and time to resumption of normal diet (3.5 d vs 5.5 d, P = 0.002). Time interval between operation and initiation of adjuvant chemotherapy was significantly shorter in the ERAS group (37 d vs 49 d, P = 0.009).

CONCLUSION: The ERAS programme in the setting of emergency colorectal surgery was safe and feasible. It achieved significantly shorter hospitalisation and faster recovery of bowel function.

Keywords: Colorectal cancer; Obstruction; Emergency surgery; Enhanced recovery after surgery; Enhanced recovery programme; Outcome

Core tip: The present study is the first study examining the outcomes of enhanced recovery after surgery (ERAS) programme in the setting of emergency colorectal surgery. This study demonstrated that ERAS programme was also safe and beneficial in non-elective surgical setting. Comparing with a conventional postoperative care, ERAS programme in emergency tumour resection for obstructing colorectal cancer was associated with a significantly shorter length of hospital stay and faster recovery of bowel function, without an increase in 30-d mortality and readmission.